For the first time in several years, the Centers for Medicare & Medicaid Services held a Section 111 NGHP Town Hall webinar. The webinar focused on common issues that arise in the mandatory insurer reporting process. While the scripted portion of the webinar was relatively uneventful, CMS provided important information in a lively question and answer discussion. Here is the critical information non-group health plans (NGHPs) need to know.
The scripted portion of the webinar was handled by Angel Pagan of the Benefits Coordination & Recovery Contractor (BCRC). BCRC and CMS representatives covered a number of Section 111-related topics during the scripted portion of the call, including:
Following the scripted portion, BCRC and CMS representatives took questions from industry representatives. The most important of these questions was actually “seeded” by CMS. CMS addressed the question of indemnity-only workers’ compensation settlements. For the last decade, workers’ compensation practitioners have relied upon general guidance to make their own determination of whether indemnity-only workers’ compensation settlements qualify as a total payment obligation to the claimant (“TPOC”) event, which is subject to mandatory reporting requirements when a Medicare beneficiary is involved. CMS representatives answered the question unequivocally, noting that indemnity-only settlements are not TPOC events because they do not release a claim for medical benefits – they are simply releasing the wages portion of a claim.
The announcement will not have major impact for many responsible reporting entities (RREs). Nevertheless, for those who have either reported indemnity-only settlements in the past as a TPOC event or are unsure of how to proceed, the best approach is as follows:
Medicare’s Section 111 User Guide runs five volumes and hundreds of pages, yet for the last ten years virtually nothing has been said about indemnity-only settlements. The answer provided on the Town Hall call is not currently included in the Section 111 User Guide. We hope that CMS continues to amend the User Guide to include this guidance, in writing.
CMS and BCRC representatives answered a variety of other questions, including questions about ICD codes, future calls on civil monetary penalties, Medicare Advantage Plan access to Section 111 data, and more. A full transcript of the call as well as copies of the slides will be available on CMS’ web site within the next week or so.
ECS has the largest and most experienced team of Section 111 reporting experts in the country. If you have any questions about the Town Hall call or looming civil monetary penalties, please reach out to our team to check on your existing Section 111 reporting process. If you have an obligation to report but have not yet registered – do not delay. Contact our Mandatory Insurer Reporting Team at MIRService.Support@examworkscompliance.com or 678-222-5454 to schedule an evaluation today.